Provider Information for 1295770725
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FRED MEYER STORES INC
Other Names:Doing Business As:FRED MEYER PHARMACY #653Organization Subpart: NO
NPI: 1295770725
Last Updated: 2020-10-14
Certification Date: 2020-10-14
Certification Date: 2020-10-14
Details
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NPI | 1295770725 | ||||||||||||||||||||
Enumeration Date | 2006-06-18 | ||||||||||||||||||||
NPI Type | NPI-2 Organization | ||||||||||||||||||||
Status | Active | ||||||||||||||||||||
Authorized Official Information | Name: ALLISON MUENNICH Title: MANAGER OF PHARMACY LICENSING Phone: 5137621019 | ||||||||||||||||||||
Mailing Address | PO BOX 842772 BOSTON, MA 02284-2772 United States Phone: 513-762-1019 | Fax:513-762-1092 | ||||||||||||||||||||
Primary Practice Address | 1501 E PARKS HWY WASILLA, AK 99654-8283 United States Phone: 907-352-5033 | Fax:907-352-5027 | ||||||||||||||||||||
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